ELIZA LEE GORDON PHD
NPI 1104384098
Psychologist - Clinical in Chesterfield, MO

Q: What is Eliza Gordon's NPI number?

The NPI number for Eliza Gordon is 1104384098. It was assigned to this individual provider in the NPPES registry on March 9, 2019. The provider is also known as Ellie Gordon Phd.

Q: What is Eliza Gordon's specialty?

The primary specialty registered for this NPI is Psychologist, specializing in Clinical, with taxonomy code 103TC0700X.

Q: Is Eliza Gordon enrolled in Medicare?

No. Eliza Gordon has opted out of Medicare through July 1, 2028. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out.

Q: When was this NPI record last updated?

The NPPES record for Eliza Gordon was last updated on September 21, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since March 09, 2019Opted out of Medicare · through Jul 1, 2028

15480 ELK RIDGE LN, CHESTERFIELD, MO 63017(801) 683-9068 Get Directions Write a Review

NPPES record last updated: September 21, 2022. Verified against the NPPES registry weekly; last sync: September 13, 2026.

Record update history: Sep 21, 2022, Aug 11, 2022, Dec 17, 2021 and 2 more (5 updates tracked since 2019).

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About Eliza Lee Gordon Phd NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

ELIZA LEE GORDON PHD (NPI 1104384098) is an individual clinical provider in Chesterfield, Missouri, licensed in Missouri (2022012232) and active in the NPI registry since March 2019. She has opted out of Medicare through July 1, 2028.

NPPES Registry Identity

NPI1104384098

Entity TypeIndividualFemale

Primary Taxonomy103TC0700X

Provider Legal NameELIZA LEE GORDONCredential: PHD

Location Address15480 ELK RIDGE LNChesterfield, MO 63017-5313

Mailing Address1734 Clarkson Rd # 1122Chesterfield, MO 63017-4976 · (801) 683-9068

Phone(801) 683-9068

Sole ProprietorNo

Enumeration DateMarch 9, 2019

Last NPPES UpdateSeptember 21, 20225 updates tracked since enumeration

NPPES CertifiedSeptember 21, 2022

✔ NPI 1104384098 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyPsychologist · ClinicalBehavioral Health & Social Service Providers

Taxonomy Code103TC0700X

License✔ Licensed in MO · 2022012232

Definition

A psychologist who provides continuing and comprehensive mental and behavioral health care for individuals and families; consultation to agencies and communities; training, education and supervision; and research-based practice. It is a specialty in breadth -- one that is broadly inclusive of severe psychopathology -- and marked by comprehensiveness and integration of knowledge and skill from a broad array of disciplines within and outside of psychology proper. The scope of clinical psychology encompasses all ages, multiple diversities and varied systems.

Also ListedPsychologist · HealthTaxonomy 103TH0004X · License 2022012232 (MO)

15480 ELK RIDGE LN, Chesterfield, MO 63017

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Other Names 1

Other Name (5)Ellie Gordon Phd

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

ⓘ

Opted out of Medicare

Eliza Lee Gordon Phd has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from July 1, 2024 through July 1, 2028.

Opt-Out Effective DateJuly 1, 2024

Opt-Out In Effect ThroughJuly 1, 2028Opt-out affidavits renew automatically every two years unless cancelled

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Eliza Gordon's NPI number?

The NPI number for Eliza Gordon is 1104384098. It was assigned to this individual provider in the NPPES registry on March 9, 2019. The provider is also known as Ellie Gordon Phd.

Where is Eliza Gordon located?

Eliza Gordon practices at 15480 Elk Ridge Ln, Chesterfield, MO 63017. The listed phone number is (801) 683-9068.

What is Eliza Gordon's specialty?

The primary specialty registered for this NPI is Psychologist, specializing in Clinical, with taxonomy code 103TC0700X.

Is Eliza Gordon enrolled in Medicare?

No. Eliza Gordon has opted out of Medicare through July 1, 2028. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out.

When was this NPI record last updated?

The NPPES record for Eliza Gordon was last updated on September 21, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.